From Structure to Process: On the Integration of AMPD and HiTOP

Abstract

In recent years the limitations of traditional categorical frameworks for conceptualizing and diagnosing psychopathology have become increasingly clear, prompting the development of dimensional models wherein psychological dysfunction is assessed on a series of continua. Two frameworks have been particularly influential: the Alternative Model for Personality Disorders (AMPD) outlined in DSM–5 (American Psychiatric Association, 2013), and the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017). Widiger et al.’s timely and insightful review addresses two key questions regarding AMPD and HiTOP: Do deficits in self- and interpersonal functioning (AMPD Criterion A) have incremental validity over maladaptive traits (Criterion B), and if so, should Criterion A be included in HiTOP? In this commentary I argue that to resolve these questions conclusively, studies of factor structure and construct covariation must be complemented by investigations that address three issues: (a) Are there identifiable causal links between Criterion A impairments and Criterion B traits; (b) Do salient life events, therapeutic interventions, and experimental manipulations differentially affect Criterion A and Criterion B scores; and (c) Do Criterion A and Criterion B scores predict different outcomes in laboratory, clinical, and field settings?.